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Sunday, December 26, 2010

Laughter is the Best Medicine

No one wants to be in the hospital at Christmas.

Well, maybe some people do, especially if they're lonely. Certainly everyone whose deductible starts over again in January seems to. But despite the urgency patients feel to have elective surgery over the holidays, I sense that none of them is really happy about it. Neither am I, for that matter. I hate that December is always my busiest month (71 cases this time around).

So, every December, there is generally an undercurrent of "Bah, humbug!" lurking in the hospital hallways, sort of like the invisible coating of drug-resistant bacteria on the ICU surfaces. This never helps me percolate any kind of holiday spirit.

Early this month, I stopped at the drugstore to pick up some toiletries. Next to the shampoo section, my eye caught a display of silly over-the-top antler headgear festooned with blinking Christmas lights. I found myself grinning a little and thinking what my son would say if I picked him up from school wearing a set of those antlers. So I bought a set out of mischief - what are parents for if not embarrassing their preadolescent kids?!

On the way home, wearing those blinking antlers, I realized I was still grinning - and I came up with a very un-Grinch-like idea.

The next day, I arrived in preop holding wearing my white coat... and my antlers. The staff gaped, then giggled. I went to see my first patient and watched the anxiety on her face melt into laughter. She rolled back to the OR still smiling. And so it went, all day long. It was the most fun I'd had on a workday in December since - who knows?

The OR staff enjoyed it so much that on my next OR day, several of them brought in Christmas headdresses of various types: elf ears, Santa hats, snowflake crowns. I myself bought enough headgear that I wore a different set every operating day through the 23rd. My inpatients looked forward to seeing what would come next; one actually wanted to stay an extra day just to see what my head would look like. Every patient seemed a little brighter than usual this month (a lot like my head!).

I have always thought that humor is a key to communicating with patients and making them feel at ease. I use it whenever I can. My Christmas headgear experience has made me realize how big a difference it can really make, not just in the patients, but in us as physicians, too. A laugh can dispel the shadows of fear in a patient's mind; they're all afraid, each in their own way. We, too, are afraid - of the things we can't control, of the grimness of disease and death. Just as the Hogwarts students could dispel creatures resembling their greatest fears with humor ("Riddikulus!"), so do we have the power to help our patients and ourselves grapple with the dread of illness.

I wish we all could recognize this. Interesting, some of the comments I heard from my colleagues when they saw my festive antlers. Twice: "I don't know if I'd have the confidence to have someone wearing those operate on my brain!" "Do you really let your patients see you in those?!" Most telling: "I bet not many neurosurgeons would be seen wearing those..."

No, sadly, probably not. Ours is notoriously such a dignified, serious profession. The classic image of a neurosurgeon is a tall, graying man in a suit and tie with a grave expression who can burst into a tirade at the drop of a hat. No smiles, no fun, and certainly no antlers for him! After all, the patients and the world must hold him in the utmost regard! I have always secretly been pleased to look (and to be) nothing like that classic stereotype. Our field needs more laughter... and more humanity.

That's the comment (from a chaplain) that struck me most: "I am glad to see you wearing that. It lets the patients see that you are human."

Indeed. I couldn't agree more. If I learned anything from my Christmas antler experiment, it is that many physicians still take themselves too seriously. We have an important job, no question. But if we are to give our patients the best care, we must find ways to connect with them on a human level. We need to pay less attention to our dignity and more to empathy, all year round. A little laughter, sometimes directed at ourselves, would go a long way in all our relationships.

In this season, we celebrate the Incarnation, the perfect divine coming to share the imperfect human experience. What a good time to put the physician "God complex" behind us and show our patients that we, too, can listen, can cry, and ... yes, can laugh.

amazing! i plan on doing the same thing in my practice...although i'm going into peds so that's a little more "acceptable" in my field than in yours. more power to ya for doing it! i might INSIST that any surgeon who ever wants to work on me will wear christmas headgear :)

Awesome post! I could get most kids to sit through an exam after I make my nose glow with an otoscope. They love it and will usually want me to make their ears glow too. Makes my job a lot easier...and more fun.

I think this is one of the secrets to life and i must admit the "taking themselves too seriously" syndrome is why I have a bit of fear and disconnect for most surgeons but this post just adds to my growing hope that there might be generational and, dare I say, it a gender change to this in train. Awesome post!

Absolutely loved this post...it reminded me of the neurosurgeon I once knew as a patient, since he, too, managed to show me both the absolutely serious side of medicine and a warped sense of humor that gave me the human part of it as well. He didn't fit that classic stereotype of a neurosurgeon, either; the ones who did wouldn't operate on me as a 2kg baby! I would loved to have seen all your headgear.

Good for you. I am one of the few attendings at my hospital who dresses up for Halloween pretty much without fail. I find that the nurses, patients, and early years med students love it, the housestaff are a mix of amused and concerned, and the attendings with few exceptions give me a patronizing smile/perplexed glance and then continue on as though I'm not in a costume. It's not 100% but it's awfully close. Telling reactions, all, and it speaks to the extent to which the various groups have had their "common humanity" beat out of them by training.

Gizabeth: I think you should wear the hat next year and see what happens! This was a fun experiment.

Tempeh: I'm glad there's someone else out there who has done something like this. I find it very interesting that you get exactly the same reactions as I got. The description of "patronizing smile and perplexed glance" is spot on.

My baby was in the PICU last year from 12/26-1/5. I was told that I just missed Christmas, when all the PICU doctors and staff not only had Santa hats on... but they (within ability) Santa-hatted every kid in the PICU as well.

On New Years, they brought around sparkling cider to every parent there for midnight. It was great. There's absolutely nothing wrong with smiling while you're stuck there.

Keep the laughter coming by preparing for Global Belly Laugh Day, January 24. On Global Belly Laugh Day we celebrate the great gift of laughter. The celebration of laughter is playful, easy and fun. On January 24 at 1:24 p.m. (your local time) smile, throw your arms in the air and laugh out loud. Join the Belly Laugh Bounce 'Round the World.Knowing you are going to laugh on January 24 boosts your spirits.Perhaps your hospital can post signs about Global Belly Laugh Day.a printable sign is atwww.bellylaughday.comJanuary 24, 2011 is the fifth anniversary of Global Belly Laugh Day.with a smile and a belly laugh,Elaine Helle

Tempeh, I did it too, in the ER, where humour is more accepted than neurosurgery. At least 5 years ago, BK (before kids), I borrowed some wigs at Hallowe'en and wore a curly black wig with devil's horns all day.

I also brought two more white wigs, draped them on a pumpkin, and invited other nurses/docs to wear them, too. To my intense disappointment, two tried them on but immediately removed them.

"Would you wear that to a code?" someone asked me.

"Why not?" I replied. "It shouldn't affect the sterile field."

As it turned out, I had trouble getting a subclavian/IJ line in that day, but the patient was unconscious, so he didn't object to the wig.

The license to be silly or funny when the occasion permits is one of the best things about being in pediatrics. I wish it was more accepted in adult medicine- I think the humor would help just as much, if not more.

Artemis: LOL! Actually, I wondered if anyone would "get" my moniker - it's a little obscure for those outside of neuro specialties or trauma surgery. Hopefully I (and all of us) will remain a GCS15 for a very long time to come! :-) Happy New Year!

I love having humor in the workplace as well. Back in the day, when I was working Medicine and Peds, it seemed easier for me to dress up for Halloween or other holiday b/c I was ALSO a pediatrian. It never even occurred to the internists I worked with that you could dress up and have fun with the clinic practice

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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